Abstract
Abstract: :
Purpose:To evaluate the combination of photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (TAAC) injection in the treatment of choroidal neovascularization (CNV) due to age–related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS). Methods:Thirteen eyes in 13 patients with CNV were included in the study. Seven eyes with no prior treatment were classified as the "no prior treatment" group. Six eyes with prior treatment with PDT only were classified as the "prior PDT" group. All patients were treated with PDT with verteporfin followed immediately by an intravitreal injection of 4 mg of TAAC. LogMAR visual acuity (VA), intraocular pressure (IOP), fundus exam and fluorescein angiogram (FA) were followed. Subsequent retreatment with PDT was based on FA evidence of leakage at follow up. Results:Patients in the "no prior treatment" group had a VA of 0.69 ±0.58 at baseline and 0.60 ±0.62 at 3 months, while four of these patients had a VA of 1.0 ±0.60 at baseline and 0.83 ±0.79 at 6 months. One of the 4 patients required an additional treatment with PDT. No patients showed a decrease in VA in this group. For the "prior PDT" group, baseline VA was 0.87 ±0.70. Five patients were followed for 3 months with a VA of 0.74 ±0.70. One patient required 2 additional treatments with PDT and had stabilized VA and no leakage on FA at 12 months. One patient showed a one line decrease in VA in this group. In a subgroup analysis of the four patients with POHS, VA change was 0.33 ±0.30 at baseline to 0.15 ±0.19 at 3 months. Only one patient in this study showed temporary mild elevation of IOP which spontaneously returned to normal. Follow up is ongoing. Conclusions:Our data suggest that PDT combined with intravitreal TAAC injection is safe, and at least the same as or better than PDT alone for stabilization of VA and CNV leakage caused by AMD or POHS. Our results are consistent with a previous report in a similar case series1 and indicate that combination treatment can be used as first line therapy. In addition, the patients with POHS showed a marked improvement in VA, however this improvement is not statistically significant due to small sample size. To our knowledge, this is the first report of combination therapy in POHS patients. A larger series of patients and longer follow up are needed to compare combination therapy verses PDT alone for treatment of CNV. 1. Spaide R et al. Ophthalmology 2003;110:1517–1525.
Keywords: photodynamic therapy • choroid: neovascularization • age–related macular degeneration